Telepsychiatry and other technologies for integrated care: evidence base, best practice models and competencies

Hilty, Donald M.; Sunderji, Nadiya; Suo, Shannon; Chan, Steven; McCarron, Robert M.

doi:10.1080/09540261.2019.1571483

Cited by 69 publications

(70 citation statements)

References 103 publications

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“…Psychiatric services via internet and mobile technologies facilitate integrated, patient-centered practices for discrete and timely care. Telepsychiatry has been evaluated on several levels and found to be effective in terms of patient acceptance and the ability to increase access to care, and with comparable outcomes to in-person services [27]. Understanding psychiatric ED user profiles and analysis of the pertinence of their admissions to EDs may contribute to developing and optimizing such alternative mental health strategies [28].…”

Section: Introductionmentioning

confidence: 99%

Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry

Costanza

Mazzola²,

Radomska

et al. 2020

Medicina

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Background and Objectives: Psychiatric disorders constitute frequent causes of emergency department (ED) admissions and these rates are increasing. However, referring to ED a whole range of conditions that could or should be dealt with elsewhere is imposing itself as a problematic situation. We aimed: (1) to provide a descriptive picture of the socio-demographic and diagnostic characteristics of the visits among adults at the psychiatric ED; (2) to estimate the clinical pertinence of these visits. Materials and Methods: Retrospective analysis of diagnostic/socio-demographic characteristics and clinical trajectories of patients admitted for a psychiatric condition at the adult psychiatric ED of the University Hospital of Geneva (HUG), Switzerland, during a 6-week timespan. Results: In our sample (n = 763 total admissions for psychiatric conditions; n = 702 for inclusion of patients having received a medical evaluation), depression/anxiety, suicidal behavior (SB), psychotic episode, and substance use disorder (SUD), in descending order, were the most common diagnoses for referral. Patients belonged to younger age groups (≤65 years), had a familial status other than married/in couple, and did not present an unfavorable socio-demographic profile. Concerning the pertinence for a psychiatric ED, primary diagnosis of depression/anxiety is the only variable significantly associated with different grade of degree. By the examination of the patients’ trajectory from admission to discharge, the clinical pertinence for a psychiatric ED admission existed for cases assigned to the Echelle Suisse du Tri (EST®) scale degree 1 (corresponding to most urgent and severe conditions), particularly for diagnoses of depression/anxiety associated with SB, SB as primary or comorbid diagnosis, and psychotic and manic/hypomanic episode. However, diagnoses of depression/anxiety without urgent and severe features (degrees 2, 3, 4) constituted the most frequent mode of presentation. Conclusions: Ambulatory and community-integrated settings could be more appropriate for the majority of patients admitted to adult psychiatric EDs. Moreover, the implementation of telepsychiatry strategies represents a very promising opportunity to offer these patients care continuity, reduce costs and filter the demand for psychiatric ED.

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Section: Introductionmentioning

confidence: 99%

Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry

Costanza

Mazzola²,

Radomska

et al. 2020

Medicina

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“…Applying a training that primarily targets technical competency, we are confident that we will minimise potential difficulties with handling video consultations and consequently minimise task-related expenses. In fact, technical competency is regarded as crucial for successfully implementing telepsychiatry services 32. Additionally, we will address remaining questions and equip the teams with a study handbook including description of the secure videoconferencing platform and contingency plans in case of technical failures.…”

Section: Methods and Analysismentioning

confidence: 99%

Mental health specialist video consultations for patients with depression or anxiety disorders in primary care: protocol for a randomised controlled feasibility trial

et al. 2019

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IntroductionMost people suffering from depression and anxiety disorders are entirely treated in primary care. Due to growing challenges in ageing societies, for example, patients’ immobility and multimorbidity, the transition to specialised care becomes increasingly difficult. Although the co-location of general practitioners and mental health specialists improves the access to psychosocial care, integrated in-person approaches are not practical for rural and single-doctor practices with limited personnel and financial resources. Treating primary care patients via internet-based video consultations by remotely located mental health specialists bears the potential to overcome structural barriers and provide low-threshold care. The aim of this randomised controlled feasibility trial is to investigate the feasibility of implementing of mental health specialist video consultations in primary care practices.Methods and analysisFifty primary care patients with significant depression and/or anxiety symptomatology will be randomised in two groups receiving either the treatment as usual as provided by their general practitioner or up to five video consultations conducted by a mental health specialist. The video consultations focus on (1) systematic diagnosis plus proactive monitoring using validated clinical rating scales, (2) the establishment of an effective working alliance and (3) a stepped-care algorithm within integrated care adjusting treatments based on clinical outcomes. We will investigate the following outcomes: effectiveness of the recruitment strategies, patient acceptance of randomisation, practicability of the technical and logistical processes related to implementing video consultations in the practices’ workflows, feasibility of the data collection and clinical parameters.Ethics and disseminationThis trial has undergone ethical scrutiny and has been approved by the Medical Faculty of the University of Heidelberg Ethics Committee (S-634/2018). The findings will be disseminated to the research community through presentations at conferences and publications in scientific journals. This feasibility trial will prepare the ground for a large-scale, fully powered randomised controlled trial.Trial registration numberDRKS00015812.

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“…With further experience, the role may be modified but the initial iteration of the digital clinic will feature LAMP and the digital navigator in these roles that are intended to support a strong therapeutic alliance where it matters the most. As digital clinics evolve and build evidence, practice models and competencies will be a next step in dissemination (Hilty et al 2019).…”

Section: Digital Psychiatry Clinicmentioning

confidence: 99%

Creating a Digital Health Smartphone App and Digital Phenotyping Platform for Mental Health and Diverse Healthcare Needs: an Interdisciplinary and Collaborative Approach

Torous

Wisniewski

Bird³

et al. 2019

J. technol. behav. sci.

136

107

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As the potential of smartphone apps and sensors for healthcare and clinical research continues to expand, there is a concomitant need for open, accessible, and scalable digital tools. While many current app platforms offer useful solutions for either clinicians or patients, fewer seek to serve both and support the therapeutic relationship between them. Thus, we aimed to create a novel smartphone platform at the intersection of patient demands for trust, control, and community and clinician demands for transparent, data driven, and translational tools. The resulting LAMP platform has evolved through numerous iterations and with much feedback from patients, designers, sociologists, advocates, clinicians, researchers, app developers, and philanthropists. As an open and free tool, the LAMP platform continues to evolve as reflected in its current diverse use cases across research and clinical care in psychiatry, neurology, anesthesia, and psychology. In this paper, we explore the motivation, features, current progress, and next steps to pair the platform for use in a new digital psychiatry clinic, to advance digital interventions for youth mental health, and to bridge gaps in available mental health care for underserved patient groups. The code for the LAMP platform is freely shared with this paper to encourage others to adapt and improve on our team's efforts.

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Telepsychiatry and other technologies for integrated care: evidence base, best practice models and competencies

Cited by 69 publications

References 103 publications

Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry

Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry

Mental health specialist video consultations for patients with depression or anxiety disorders in primary care: protocol for a randomised controlled feasibility trial

Creating a Digital Health Smartphone App and Digital Phenotyping Platform for Mental Health and Diverse Healthcare Needs: an Interdisciplinary and Collaborative Approach

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